Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study

Aims: Compare quantitative ultrasound (QUS) of calcaneus and dual energy X-ray absorp-tiometry (DXA) as measurements of bone density, calculate 20-year fracture incidence in patients with T1DM and T2DM and multiple complications, and compare the methods' pre-dictive ability. Methods: Sixty-two hospital foot clinic patients with T1DM or T2DM and complications were followed (1995-2015; 610 person-years). Clinical assessments and QUS of calcaneus were per -formed on all at inclusion and DXA of the spine and femoral neck on a subgroup (n = 34). Frac-ture incidence was assessed at follow-up and compared to incidence in the general population. We evaluated the correlation between QUS of calcaneus and DXA (Pearson's cor-relation test) and the association between bone density and fracture incidence at follow-up (logistic regression). Results: Bone density (QUS of calcaneus) correlated with hip bone density (DXA). Incidence of all fractures (30/62 patients; 48%) and hip fractures (6/62 patients; 10%) was higher in patients than the general population. Twelve (19%) experienced foot fracture. QUS of calcaneus pre-dicted hip, lower leg, and foot fractures; DXA did not. Conclusions: Because QUS of calcaneus predicted fractures in patients with diabetes and mul-tiple complications, it seems appropriate to test QUS of calcaneus as a fracture risk predictor in primary care. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).